SHIBU PORINCHU PERUMBULLY

OAK LAWN, IL
NPI1346507811
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: IL  160.005937)
Enumeration Date2012-04-20
Last Update Date2012-04-20
Business Address
-- SHIBU PORINCHU PERUMBULLY PTA
9725 S KARLOV AVE
OAK LAWN, IL 60453-3388
Phone number: 708-422-1461
Mailing Address
-- SHIBU PORINCHU PERUMBULLY PTA
9725 S KARLOV AVE
OAK LAWN, IL 60453-3388
Phone number: 708-422-1461
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